Augmented Reality, Other Trainers for Complex Disease

When the economy showed signs of instability in 2007, Lindsay Murphy was laid off from her job at a hospital. Two years later, still with no job and no health insurance, she had to file bankruptcy and lost her home. But tough finances were not the main source of her anxiety—even more difficult for Lindsay was not knowing the cause of her severe bleeding and pain. Without insurance, she began to visit a popular clinic dedicated to women’s health for her care.

What transpired was a long road of misdiagnosis, which she later learned is common in endometriosis patients. The clinic’s doctors said she had pelvic inflammatory disease. They gave her a shot, but she continued to reel in pain. Upon return, she was put on antibiotics and asked to leave.

Lindsay Murphy's Story

I had a hysterectomy at 33 years old. It truly released me from my pain and gave me a chance at a high-quality life. To this day, there is no pain. My surgeon removed my endometriosis, but there is still no cure for the disease. It's been a long road to recovery, and I've had to learn to manage the damage the disease has done. I've made tremendous progress. Although I’m not the athlete I was years ago, I am active. After years of no answers and four surgeries, I now have a pain-free life. I feel good that I helped the medical community learn more about the disease, but there are still many more questions than answers.

After a job interview in Denver, she collapsed on the street; when she woke, she called her mother. “That is no UTI,” she said. It would take another three years of misdiagnosis and botched surgeries before Lindsay would finally recover, finding relief from debilitating pain. She eventually found a trained specialist and endometriosis was finally diagnosed.

It took a well-trained surgeon.

“This is a specialty disease,” says Mary Lou Ballweg, president of the Endometriosis Association, a worldwide group dedicated to research and awareness of the disease. “It is the characteristic of determination that I have come to appreciate—those doctors who keep coming back to understand the disease.” She points out that 89 million women around the world have endometriosis and are searching for effective treatment, concerned about pain and infertility. “It is ruining their lives.”

Even more women, one in four, have fibroids. And there are many other undetected, misunderstood diseases that are complicated to treat. Lowering the numbers and the costs that go with them actually requires investment that will lead to better detection and surgical training.

“A four-year residency is not enough,” says Mona Orady, MD, director of Robotic Surgery Education at Cleveland Clinic: “I see women after they have had unfinished, poorly performed surgeries every single day.” Orady believes hospitals need to adopt stratification where they designate what is routine and what requires simulation and other forms of surgical training. “There are higher levels of care and, for that, high-quality training is essential.”

Orady encourages simulation training by incentivizing it. She sets the bar and requires passage in order to operate. Many other centers of excellence are now setting their own requirements. The Robotic Training Network (RTN) has unified robotics training and testing at over 50 institutions, with participating hospitals including Johns Hopkins and Harvard. The RTN curriculum, which includes cognitive testing and skills evaluation through physical models and simulation, is growing rapidly in popularity.

At Columbia, we have begun implementing the RTN curriculum on both the resident and fellow training level. As the Vice-Chair & Chief of Gynecology at Columbia University Medical Center, I can tell you that the days of learning-as-you-go on patients are not acceptable. Surgeons must simulate to proficiency before entering the actual operating room.

What’s New?

Most hospitals that use the da Vinci® robot also use simulation training to some degree. This technology, created by Mimic Technologies, has been independently validated by research and academic medical centers around the country. Mimic has also recently developed training technology for traditional laparoscopic surgery that supports the surgical assistant in robotic procedures. The goal is to help all members of a robotic surgical team perform at a high level.

Mimic’s training director, Todd Larson, is a former Walter Reed Army Medical Center specialist, and agrees with Orady that most surgeons coming directly out of residency have not reached a level of competency that allows them to perform advanced surgical procedures. Consequently, they will seek Fellowship training or some other advanced training to acquire those skills. Mimic Technologies has partnered with the Florida Hospital Nicholson Center to develop simulation training to aid the specialist in safely acquiring advanced skills.